Epilepsy is a domestically intrusive disease which is socially concealed, affects all social classes and ethnic groups, and is common in women of child-bearing age. Excellence in care during pregnancy produces significant benefits for these mothers and their families. There were 13 maternal deaths due to suboptimal management of epilepsy in pregnancy in the latest report of the Confidential Enquiry into Maternal Deaths in the UK. One additional death was classified as a head injury but occurred following a seizure. Correct diagnosis, classification and investigation of epilepsy, contraception advice, preconceptual counselling, use of safest monotherapy, close monitoring of drug side-effects and efficacy in pregnancy, screening for fetal anomalies, high dose folic acid and vitamin K, seizure prevention in labour, and supportive advice for parenting are the mainstays of good maternal medicine.